MEDICARE: MR. RICHARD DAVID LEPORE MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC40906	CA

General Provider Information

NPI Number	:	1881791465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD DAVID LEPORE MFT

Provider Business Mailing Address
First Line	:	645 WESTMOUNT DR APT 211
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-5173
Country	:	US
Telephone Number	:	323-243-9977
Fax Number	:	310-499-5610

Provider Business Practice Location Address
First Line	:	9021 MELROSE AVE STE 201A
Second Line	:	WEST HOLLYWOOD
City	:	LOS ANGELES
State	:	CA
Zip	:	90069-5691
Country	:	US
Telephone Number	:	310-499-5610
Fax Number	:	310-499-5610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	10/21/2011

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